Lawmaker to Feds: Make Florida Give Poor Kids Healthcare

By Carol Marbin Miller, The Miami Herald

U.S. Rep. Kathy Castor is asking federal health administrators to investigate Florida’s “outrageous and miserable history” of denying adequate healthcare to impoverished and disabled children, saying the state has deliberately ignored a judge’s ruling that Florida’s insurer for the needy is systematically violating federal law.

In a letter Thursday, Castor called upon Sylvia Burwell, the secretary of the U.S. Department of Health and Human Services, to “exercise [her] oversight and enforcement authority to ensure Florida children receive the care required under the law.”

By sending the missive, Castor, a Tampa Democrat, is wading into a dispute between state health administrators and doctors for impoverished children that simmered for a decade before reaching a boiling point last year. On the last day of December 2014, U.S. Circuit Judge Adalberto Jordan declared Florida’s healthcare system for needy and disabled children to be in violation of several federal laws. Jordan’s ruling was a milestone in a lawsuit by pediatricians and several families that had been filed 10 years earlier.

Florida’s spending for the healthcare of children in Medicaid, the state’s insurer for the needy, is so inadequate, Jordan wrote in a 153-page ruling, that most pediatricians and specialists have been driven from the program. As a consequence, the judge wrote, poor and disabled children often endure long waits for an appointment, or travel hours to a population center to see a doctor.

Speaking of the lawsuit, Castor wrote: “The court’s findings of fact and conclusions of law revealed an outrageous and miserable history by the state of Florida of systematically and purposefully ignoring its duty to provide adequate care for children and meet its legal and moral responsibilities.”

“Despite the fact that eight months have passed since the ruling, the state has done nothing to address the shortcomings in medical services to children, as the court directed. In fact, the state has exacerbated the problems and continues to ratchet back on required children’s health programs,” Castor added.

In recent court pleadings, the state Agency for Health Care Administration insisted the judge’s findings were based on evidence gleaned years earlier; a statewide shift to Medicaid managed care has rendered the case moot. “The Florida Medicaid program has gone through numerous fundamental changes,” one pleading said, and children’s advocates can muster only isolated anecdotes to show children continue to suffer.

Late last month, the Miami Herald reported, the majority of doctors who oversee Florida’s Children’s Medical Services accused the state of “dismantling” the program. About 20 of CMS’ medical directors or assistant medical directors signed a letter saying the Department of Health tampered with a screening tool in order to purge frail and disabled children from CMS, which was once considered a national model for the treatment of sickly children.

The medical directors say a rescreening of the state’s 77,990 children in CMS is likely to cast one in four children from enrollment, including youngsters with heart ailments, kidney disease, blindness and the virus that causes AIDS.

Children who are removed from CMS as part of the health department’s rescreening likely will end up in a privately run managed care program funded by Medicaid — the state insurer Jordan wrote already was essentially rationing scarce taxpayer dollars.

A spokeswoman for the state Department of Health did not respond late Thursday to a reporter seeking comment on the letter.

Last month, health administrators denied the medical directors’ accusations, saying that the controversial screening tool that has pushed thousands of children out of the program “was carefully and thoughtfully developed to ensure that CMS is serving children with special healthcare needs as directed by the Legislature.”

“The Florida Department of Health’s Children’s Medical Services’ (CMS) staff is committed to serving Florida’s most vulnerable population,” DOH spokeswoman Tiffany C. Cowie said in an email.

Castor, who sits on the House Energy and Commerce Committee’s Heatlh Subcommittee, requested that federal regulators initiate “rigorous oversight” of the state’s children’s health program.

“It is highly questionable that the managed care plans will provide the necessary and qualified providers and services these children need. Instead, knowledgeable medical directors advise that the children should remain with current health providers who know the children, their families and complex special needs,” Castor wrote.

“It is unconscionable that even after a U.S. District Court ruling, the state of Florida and Gov. [Rick] Scott continue to evade their legal responsibilities to ensure access to care for children as required by law,” Castor wrote. “I strongly advise that you work with medical directors at [CMS], pediatricians, dentists and advocates to hold Florida officials’ feet to the fire to ensure pediatric providers receive the reiumbursement they are entitled to and, most importantly, that children receive the care they deserve.”